WATAWAT NG PILIPINAS
Ang pambansang watawat ng Pilipinas ay may araw na walo ang sinag, at tatlong bituin, parehong kulay ginto, at nakapatong sa puting tatsulok na equilateral. Sa gawing taas ng natitirang bahagi ay ang kulay asul at sa ibaba nito ang kulay pula. Ang pagkakabagay-bagay ng watawat ay 1:2.Ang watawat ay unang naisip gawin ni Emilio Aguinaldo. Si Marcela Agoncillo, ang kanyang anak na si Lorenza, at ang pamangkin ni Jose Rizal na si Josefina Herbosa de Natividad ang nagtahi ng unang bandila sa Hong Kong. (Sa ibang aklat, ang pangalan ng pamangkin ay Delfina Herbosa de Natividad.)Ito ang paglalarawan sa orihinal na watawat ng Pilipinas na na-konsepto ni Hen. Emilio Aguinaldo. Mas marahan ang kulay asul nito kaysa sa kasalukuyang pinag-uutos na kulay royal blue, mas marami itong sinag noon pero walo rin ang naging mga dulo, at may mahiwagang mukha.Ayon sa Pamamahayag ng Kalayaan ng Pilipinas ng Hunyo 12, 1898, ang puting tatsulok ang natatanging sagisag ng Katipunan na sa pamamagitan ng pagsasanib ng dugo ay nakapanghikayat sa mga Pilipino na sumama sa rebolusyon. Ang tatlo nitong bituin ay kumakatawan sa tatlong heograpikal na grupo ng mga isla sa bansa: Luzon, Visayas, at Mindanao, bagama't sa Deklarasyon ng Kalayaan ng Pilipinas, ang isa sa tatlong bituin nito ay orihinal na kumatawan sa isla ng Panay, imbes na Visayas. Gayunpaman, kapwa silang nagpapahiwatig ng mismong ideya: ang pagkakaisa ng mga magkakahiwalay na tao at kultura sa iisang Nasyon. Ang walong sinag ng araw ay sumasagisag sa walong probinsyang unang nag-alsa sa Kastila: Maynila, Cavite, Bulacan, Pampanga, Nueva Ecija, Bataan, Laguna, at Batangas.Bagaman tinuturing na isang lungsod ang Maynila, ang pagkakadagdag nito sa lupon ay wasto sapagka't noong 1898, ang Maynila at ang kanyang mga suburbyo ay pinangasiwaan bilang isang hiwalay at nagsasariling probinsya. Ang lalawigang ito ay kilala ngayon bilang Pambansang Kabiserang Rehiyon.Ang kabuluhan ng mga kulay na pula, puti at asul ay ang mga sumusunod: Ang puting tatsulok ay sumasagisag sa pagkakapantay-pantay at kapatiran; asul para sa kalayaan, katotohanan, at katarungan; at pula para sa kabayanihan at kagitingan. Sinasabing hinalintulad ang bandila sa bandila ng Cuba na, tulad ng Pilipinas, ay nakikibaka para sa kalayaan mula sa Espanya noong panahong din yon. Ito ang unang opisyal na watawat na naglayong irepresenta ang bansa. Ginawa ng Katipunan sa Naic, Cavite noong 1897.Ang lilim na bughaw na ginamit sa itong watawat ay naging paksa ng kontrobersiya ng halos siyamnapung taon na ang tanda. Mula 1920 hanggang 1985, ang lilim ay navy blue hanggang sa inutos ni Pangulong Ferdinand Marcos na baguhin ito sa lilim na sky blue, mula sa abiso ng mga sirkulong kasaysayan, sa mismong lilim na ginamit sa bandila ng Cuba, na ka-alyado ng bansa noon laban sa Espanya. Dahil sa kakulangan sa materyal at istandardisasyon noong Digmaang Pilipino-Amerikano, ang mga taga-suporta ng lilim "navy blue" at "sky blue" ay nagpasa ng kanikanilang katibayan na kapwang sumasalungat sa bawat argumento. Silipin Mga Watawat ng Himagsikang PilipinoHabang klarong nilalahad ng mga opisyal na dokumentong rebolusyonaryo na ang orihinal na lilim ng asul na ginamit sa unang bandila ay azul oscura, na kung isasalin sa Filipino ay "malabong bughaw" o madilim, at kung ano ang eksaktong lilim na tinutukoy nito ang siya pa ring magiging paksa ng debate sa mga susunod na taon. Sumasang-ayon ngayon ang mga historiador na ang azul oscura na tinutukoy ay isang mas malalim na lilim kaysa sa sky blue, ngunit mas marahan naman sa navy blue.Para pagpahingahin na ang kontrobersiya, ang kasalukuyang inuutos na lilim ay royal blue, ayon sa Aktong Pangrepublika Blg. 8491. Sa kasamaang palad, ang kilos na ito ay naglikha ng panibagong kontrobersiya sa pagitan ng mga historiador at pulitiko ukol sa kung maaaring gawin ito ng gobyerno na baguhin ang mga sagisag ng kasaysayan at orihinal na kahulugan ng mga ito para lang sa kaginhawaan ng lahat.Ang watawat ng Pilipinas ay walang-kapares, sapagka't maaari nitong ipakita ang isang kalagayan ng digmaan. Kapag ang bandila ay naka-baligtad at nasa ibabaw ang pula (o nasa kaliwa kung ito ay nakatanghal na patayo), ang ibig sabihin nito ay ang Pilipinas ay nasa nakasabak sa digmaan. Ito ay unang itinaas noong Ika-4 ng Pebrero, 1899, sa simula ng labanan ng Digmaang Pilipino-Amerikano sa mga taong 1899-1913
fil.wikipilipinas.org/index.php?title=Watawat_ng_Pilipinas
www.blogcatalog.com/topic/watawat+ng+pilipinas/
Sunday, July 26, 2009
Thursday, February 26, 2009
burns
BURN INJURY
Burns are caused by a transfer of energy from a heat source to the body. It is a cell destruction of the layers of the skin and the resultant depletion of fluid and electrolytes. The depth of the injury depends on the temperature of the burning agent and the duration of contact with it. It disrupts the skin which leads to increased fluid loss, infection, hypothermia, scarring, and changes in function, appearance and body image.
A. Young children and elderly people are at higher risk for burn injury.
B. Those younger than 5 and older than 40 years old are at high risk for death after burn trauma.
CAUSES OF BURN INJURY
• Scalds (steam, hot bath water, tipped over coffee cups, cooking fluids, etc.)
• Contact with flames or hot objects (from stove, fireplace, curling irons, etc.)
• Chemical burns (from swallowing things like drain cleaner or watch batteries or spilling chemicals such as bleach on to skin.)
• Electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets )
• Overexposure to sun.
ASSESSMENT OF BURN INJURY
First-degree burns (Superficial partial-thickness burns)
The epidermis and possibly a portion of the dermis are injured. (E.g. sunburn)
S/Sx:
a. Pink to red with slight edema which subsides quickly
b. Pain may last up to 48 hours
c. Relieved by cooling
Reparative process:
a. In about 5 days, epidermis peels.
b. Itching and pink skin persist for about a week.
c. No scarring.
d. Heals spontaneously if it does not become infected within 10 days-2 weeks.
Second-degree burns (Deep partial-thickness burns)
The epidermis and the upper to deeper portions of the dermis are injured. (E.g. Scald)
S/Sx:
a. Superficial layers of the skin are destroyed.
b. Pink or red
c. Blister form ( vesicles);weeping
d. Edematous, elastic
e. Wound moist and painful
f. Deep dermal
g. Edematous reddened areas blanch on pressure.
Reparative process:
a. Takes several weeks to heal.
b. Scarring may occur
Third-degree burns (Full-thickness burns)
The epidermis, entire dermis and sometimes the underlying tissue are injured. (E.g. Burns from a flame or electrical current.)
S/Sx:
a. Destruction of epithelial cells-epidermis and dermis destroyed.
b. Reddened areas do not blanch with pressure.
c. Not painful; coloration varies from white to brown leathery devitalized tissue- eschar.
Reparative process
a. Eschar must be removed.
b. For areas larger than 3-5 cm, grafting is required.
c. Expect scarring and losses of skin function.
d. Areas require debridement, formation of granulation tissue and grafting.
TYPES OF BURNS
a. Thermal burns: Caused by exposure to flames, hot liquids, steam or hot objects.
b. Chemical burns: caused by tissue contact with strong alkali or organic compounds, systemic toxicity from cutaneous absorption occurs.
c. Electrical burns: caused by heat generated by electrical energy as it passes through the body.
d. Radiation burns: caused by exposure to radioactive source, UV light and x-rays.
WHEN TO SEEK IMMEDIATE MEDICAL HELP?
a. You think the patient has a second or third-degree burn.
b. The burned area is large, even if it seems like a minor burn. For any burns that appears to cover more than 10% of the body. Do not use wet compresses because it can cause body temperature to drop. Instead cover the area with a clean, soft cloth or towel.
c. Burn comes from fire, an electrical wire or socket or chemicals.
d. The burn is on face, scalp, hands, joint surfaces or genitals.
e. The burn looks infected (with swelling, pus, and increasing redness).
METHODS IN ESTIMATING THE EXTENT OF THE INJURY
a. Lund and Browder Method- Modifies percentage s for body segment according to age. It provides more accurate estimate of the burn size. It uses a diagram of the body divided into sections with the representative % of the TBSA for ages throughout the lifespan.
b. Palm Method- It is used to estimate percentage of scattered burns using the size of the patient’s palm (1% of BSA) to assess the extent of burn injury.
c. Rule of nine Method- an estimation of the TBSA burned by dividing the body into multiples of nine
ASSESSMENT FOR THE PATIENT WITH BURNS
a. Review the initial assessment data obtained.
b. Focus on the major priorities of any trauma patient: Airway, Breathing, and Circulation.
c. Assess respiratory status as first priority (airway patency and breathing adequacy).
d. Note any increased hoarseness, stridor, and abnormal respiratory rate and depth or mental changes from hypoxia.
e. Evaluate circulation (apical, carotid and femoral pulses).
f. Check vital signs frequently.
g. Arrange for patient with facial burn to be assessed for corneal damage.
h. Assess depth of wound and identify areas of full and partial thickness injury.
i. Assess neurologic status: consciousness, psychological status, pain and anxiety and behavior.
PHASES OF MANAGEMENT OF THE BURN INJURY
Emergent phase
Begins at the time of injury and ends with the restoration of capillary permeability usually at 48-72 hours after the injury. The primary goal is to prevent hypovolemic shock and preserve vital organ functioning. This includes prehospital care and emergency room care.
Resuscitative phase
Begins with the initiation of fluids and ends when capillary integrity returns to near normal levels and the large fluid shifts have decreased. The amount of fluid administered is based on the client’s weight and extent of injury. Most fluid replacement formulas are calculated from the time of injury and not from the arrival at the hospital. The goal is to prevent shock by maintaining adequate circulating blood volume and maintaining the vital organ perfusion.
Acute phase
Begins when the patient is hemodynamically stable, capillary permeability is restored and diuresis has begun. This usually begins 48-72 hours after the time of injury. The goal of this is infection control, wound care, wound closure, nutritional support, pain management and physical therapy.
Rehabilitative phase
This is the final phase of burn care. It overlaps the acute care phase and goes well beyond hospitalization. The goal of this phase is designed so that the client can gain independence and achieve maximal function.
MANAGEMENT OF BURN INJURY
Fluid Resuscitation
a. Indications:
a. Adults with burns involving more than 15%-20% TBSA
b. Children with burns involving more than 10%-15% TBSA.
c. Patient with electrical injury, the elderly, or those with cardiac or pulmonary disease and compromised response to burn injury.
b. The amount of fluid administered depends on how much intravenous fluid per hour is required to maintain a urinary output of 30-50ml/hr.
c. Successful fluid resuscitation is evidenced by stable v/s, adequate urine output, palpable peripheral pulses and clear sensorium.
Pain management
a. Administer Morphine SO4 or Demerol as prescribed by the IV route; avoid IM or SC routes because the absorption through the soft tissue is unreliable when hypovolemia and large fluid shifting are occurring.
b. Avoid administering oral medication because of the possibility of GI dysfunction.
c. Medicate the patient prior to painful procedures.
Nutrition
a. Maintain NPO status until the bowel sounds are heard; then advanced to clear liquids as prescribed.
b. Nutrition maybe provided via enteral tube feeding.
c. Provide a diet high in protein, carbohydrates, vitamins and minerals
Topical antimicrobial agents
Silver sulfadiazine
a. Most widely used agent and least common incidence of side effects.
b. May cause Transient leucopenia that disappears 2-3 days of treatment.
c. Used with open treatment, light or occlusive dressing.
d. Applied once or twice daily after thorough wound cleansing.
Mafenide acetate 10% cream or 5% solution (Sulfamylon)
a. Painful during and for a while after application.
b. May cause metabolic acidosis, not used if >20% TBSA
c. Cream must be reapplied 12 hours to maintain therapeutic effectiveness.
d. Solution concentration is maintained with bulky wet dressings, rewet every2-4 hours.
Other topical dressings:
a. Silver nitrate
b. Cerium nitrate
c. Povidone iodine
d. Gentamycin
e. Polymixin B-Bacitracin ointment
Auto grafting
It is a surgical removal of a thin layer of a patient’s own unburned skin, which is then applied to the excised burn wound.
Temporary wound coverings
Amnion
It comes from amniotic membrane from human placenta, dressing is changed q48hours.
Allograft (Homograft)
It is donated from human cadaver; skin is harvested within 24 hours after death. Monitor for wound exudates and infection. Rejection can occur within 24 hours.
Xenograft (Heterograft)
It is a porcine skin which is harvested after slaughter and preserved. Rejection can occur within 24-72 hours. It is replaced q2-5days until the wound heals naturally or until closure with autugraft is complete.
Biosynthetic and synthetic
A Visual inspection of the wound is possible; s dressings are transparent or translucent.
TYPES OF SKIN GRAFTING
Split thickness
Graft half of the epidermis, applied in sheets or postage stamp-like pieces.
Full thickness
Graft consisting of epidermis and dermis; it is commonly used for reconstructive surgery months or years after the initial injury.
Pedicle flap
Commonly used for reconstructive surgery months or years after the initial injury.
Cultured Epithelium
Used of the client’s unburned skin. Keratinocytes are isolated and epithelial cells are cultured in a laboratory; these cells then attached to the burned wound.
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
COLLEGE OF NURSING
General Tinio St. Cabanatuan City
Submitted by:
Karen Katrin M. Tabunan
BSN IV-J
Submitted to:
Ms. May-flor Lazatin
Ms. Marian Legaspi
Head nursing
Ms. Jean Christian Mangoba
Clinical instructor
Burns are caused by a transfer of energy from a heat source to the body. It is a cell destruction of the layers of the skin and the resultant depletion of fluid and electrolytes. The depth of the injury depends on the temperature of the burning agent and the duration of contact with it. It disrupts the skin which leads to increased fluid loss, infection, hypothermia, scarring, and changes in function, appearance and body image.
A. Young children and elderly people are at higher risk for burn injury.
B. Those younger than 5 and older than 40 years old are at high risk for death after burn trauma.
CAUSES OF BURN INJURY
• Scalds (steam, hot bath water, tipped over coffee cups, cooking fluids, etc.)
• Contact with flames or hot objects (from stove, fireplace, curling irons, etc.)
• Chemical burns (from swallowing things like drain cleaner or watch batteries or spilling chemicals such as bleach on to skin.)
• Electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets )
• Overexposure to sun.
ASSESSMENT OF BURN INJURY
First-degree burns (Superficial partial-thickness burns)
The epidermis and possibly a portion of the dermis are injured. (E.g. sunburn)
S/Sx:
a. Pink to red with slight edema which subsides quickly
b. Pain may last up to 48 hours
c. Relieved by cooling
Reparative process:
a. In about 5 days, epidermis peels.
b. Itching and pink skin persist for about a week.
c. No scarring.
d. Heals spontaneously if it does not become infected within 10 days-2 weeks.
Second-degree burns (Deep partial-thickness burns)
The epidermis and the upper to deeper portions of the dermis are injured. (E.g. Scald)
S/Sx:
a. Superficial layers of the skin are destroyed.
b. Pink or red
c. Blister form ( vesicles);weeping
d. Edematous, elastic
e. Wound moist and painful
f. Deep dermal
g. Edematous reddened areas blanch on pressure.
Reparative process:
a. Takes several weeks to heal.
b. Scarring may occur
Third-degree burns (Full-thickness burns)
The epidermis, entire dermis and sometimes the underlying tissue are injured. (E.g. Burns from a flame or electrical current.)
S/Sx:
a. Destruction of epithelial cells-epidermis and dermis destroyed.
b. Reddened areas do not blanch with pressure.
c. Not painful; coloration varies from white to brown leathery devitalized tissue- eschar.
Reparative process
a. Eschar must be removed.
b. For areas larger than 3-5 cm, grafting is required.
c. Expect scarring and losses of skin function.
d. Areas require debridement, formation of granulation tissue and grafting.
TYPES OF BURNS
a. Thermal burns: Caused by exposure to flames, hot liquids, steam or hot objects.
b. Chemical burns: caused by tissue contact with strong alkali or organic compounds, systemic toxicity from cutaneous absorption occurs.
c. Electrical burns: caused by heat generated by electrical energy as it passes through the body.
d. Radiation burns: caused by exposure to radioactive source, UV light and x-rays.
WHEN TO SEEK IMMEDIATE MEDICAL HELP?
a. You think the patient has a second or third-degree burn.
b. The burned area is large, even if it seems like a minor burn. For any burns that appears to cover more than 10% of the body. Do not use wet compresses because it can cause body temperature to drop. Instead cover the area with a clean, soft cloth or towel.
c. Burn comes from fire, an electrical wire or socket or chemicals.
d. The burn is on face, scalp, hands, joint surfaces or genitals.
e. The burn looks infected (with swelling, pus, and increasing redness).
METHODS IN ESTIMATING THE EXTENT OF THE INJURY
a. Lund and Browder Method- Modifies percentage s for body segment according to age. It provides more accurate estimate of the burn size. It uses a diagram of the body divided into sections with the representative % of the TBSA for ages throughout the lifespan.
b. Palm Method- It is used to estimate percentage of scattered burns using the size of the patient’s palm (1% of BSA) to assess the extent of burn injury.
c. Rule of nine Method- an estimation of the TBSA burned by dividing the body into multiples of nine
ASSESSMENT FOR THE PATIENT WITH BURNS
a. Review the initial assessment data obtained.
b. Focus on the major priorities of any trauma patient: Airway, Breathing, and Circulation.
c. Assess respiratory status as first priority (airway patency and breathing adequacy).
d. Note any increased hoarseness, stridor, and abnormal respiratory rate and depth or mental changes from hypoxia.
e. Evaluate circulation (apical, carotid and femoral pulses).
f. Check vital signs frequently.
g. Arrange for patient with facial burn to be assessed for corneal damage.
h. Assess depth of wound and identify areas of full and partial thickness injury.
i. Assess neurologic status: consciousness, psychological status, pain and anxiety and behavior.
PHASES OF MANAGEMENT OF THE BURN INJURY
Emergent phase
Begins at the time of injury and ends with the restoration of capillary permeability usually at 48-72 hours after the injury. The primary goal is to prevent hypovolemic shock and preserve vital organ functioning. This includes prehospital care and emergency room care.
Resuscitative phase
Begins with the initiation of fluids and ends when capillary integrity returns to near normal levels and the large fluid shifts have decreased. The amount of fluid administered is based on the client’s weight and extent of injury. Most fluid replacement formulas are calculated from the time of injury and not from the arrival at the hospital. The goal is to prevent shock by maintaining adequate circulating blood volume and maintaining the vital organ perfusion.
Acute phase
Begins when the patient is hemodynamically stable, capillary permeability is restored and diuresis has begun. This usually begins 48-72 hours after the time of injury. The goal of this is infection control, wound care, wound closure, nutritional support, pain management and physical therapy.
Rehabilitative phase
This is the final phase of burn care. It overlaps the acute care phase and goes well beyond hospitalization. The goal of this phase is designed so that the client can gain independence and achieve maximal function.
MANAGEMENT OF BURN INJURY
Fluid Resuscitation
a. Indications:
a. Adults with burns involving more than 15%-20% TBSA
b. Children with burns involving more than 10%-15% TBSA.
c. Patient with electrical injury, the elderly, or those with cardiac or pulmonary disease and compromised response to burn injury.
b. The amount of fluid administered depends on how much intravenous fluid per hour is required to maintain a urinary output of 30-50ml/hr.
c. Successful fluid resuscitation is evidenced by stable v/s, adequate urine output, palpable peripheral pulses and clear sensorium.
Pain management
a. Administer Morphine SO4 or Demerol as prescribed by the IV route; avoid IM or SC routes because the absorption through the soft tissue is unreliable when hypovolemia and large fluid shifting are occurring.
b. Avoid administering oral medication because of the possibility of GI dysfunction.
c. Medicate the patient prior to painful procedures.
Nutrition
a. Maintain NPO status until the bowel sounds are heard; then advanced to clear liquids as prescribed.
b. Nutrition maybe provided via enteral tube feeding.
c. Provide a diet high in protein, carbohydrates, vitamins and minerals
Topical antimicrobial agents
Silver sulfadiazine
a. Most widely used agent and least common incidence of side effects.
b. May cause Transient leucopenia that disappears 2-3 days of treatment.
c. Used with open treatment, light or occlusive dressing.
d. Applied once or twice daily after thorough wound cleansing.
Mafenide acetate 10% cream or 5% solution (Sulfamylon)
a. Painful during and for a while after application.
b. May cause metabolic acidosis, not used if >20% TBSA
c. Cream must be reapplied 12 hours to maintain therapeutic effectiveness.
d. Solution concentration is maintained with bulky wet dressings, rewet every2-4 hours.
Other topical dressings:
a. Silver nitrate
b. Cerium nitrate
c. Povidone iodine
d. Gentamycin
e. Polymixin B-Bacitracin ointment
Auto grafting
It is a surgical removal of a thin layer of a patient’s own unburned skin, which is then applied to the excised burn wound.
Temporary wound coverings
Amnion
It comes from amniotic membrane from human placenta, dressing is changed q48hours.
Allograft (Homograft)
It is donated from human cadaver; skin is harvested within 24 hours after death. Monitor for wound exudates and infection. Rejection can occur within 24 hours.
Xenograft (Heterograft)
It is a porcine skin which is harvested after slaughter and preserved. Rejection can occur within 24-72 hours. It is replaced q2-5days until the wound heals naturally or until closure with autugraft is complete.
Biosynthetic and synthetic
A Visual inspection of the wound is possible; s dressings are transparent or translucent.
TYPES OF SKIN GRAFTING
Split thickness
Graft half of the epidermis, applied in sheets or postage stamp-like pieces.
Full thickness
Graft consisting of epidermis and dermis; it is commonly used for reconstructive surgery months or years after the initial injury.
Pedicle flap
Commonly used for reconstructive surgery months or years after the initial injury.
Cultured Epithelium
Used of the client’s unburned skin. Keratinocytes are isolated and epithelial cells are cultured in a laboratory; these cells then attached to the burned wound.
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
COLLEGE OF NURSING
General Tinio St. Cabanatuan City
Submitted by:
Karen Katrin M. Tabunan
BSN IV-J
Submitted to:
Ms. May-flor Lazatin
Ms. Marian Legaspi
Head nursing
Ms. Jean Christian Mangoba
Clinical instructor
Tuesday, February 10, 2009
eto pa
POTT’S DISEASE
Definition
Pott’s disease is a presentation of extra pulmonary tuberculosis that affects the spine. It is also called tuberculous spondylitis. The original name was formed after Percival Pott, a London Surgeon. It is most commonly localized in the thoracic region (T9, T10) of the spine.
Causative agent
Mycobacterium tuberculosis
Predisposing factors
• Family history of pulmonary tuberculosis
• Poor environment
• Poor nutrition
• Occupation
• Lack of immunization
Signs and Symptoms
• Back pain
• Fever
• Night sweat
• Anorexia
• Weight loss
• Spinal mass
Diagnostic test
• Increase Erythrocyte Sedimentation Rate- markedly elevated due to inflammation
• Tuberculin skin test (Mantoux test/purified protein derivatives) - this determine whether an individual has been infected with the mycobacterium tuberculosis organism. The test usually consists of an intracutaneous injection of tuberculin, a purified protein derivative of the bacillus.
• Bone biopsy- surgical removal of living body tissue for the study and diagnosis. This is performed to analyze the cause and nature of the disease and on tumors or abnormal tissue growths.
• Radiograph of the spine- to determine the severity or extent of the spinal cord damage.
Medical Management
Chemotherapy
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
Vitamin C, D and B complex
Surgical Management
• Anterior Decompression Spinal Fusion (ADSF)- Best surgical intervention for Pott’s disease.
• Traction and Cast- to immobilize the affected extremities.
• Laminectomy- removal of the ruptured disks in the spine
Nursing Management
• Immobilize the spine
• Provide comfort measures.
• Reposition the patient every 2 hours by the help of other personnel.
• Inspect skin for presence of abscess.
• Increase oral fluid intake
• Encourage the patient to verbalize feelings and concerns.
• Observe for signs of respiratory distress.
• Administer medication as prescribed.
Definition
Pott’s disease is a presentation of extra pulmonary tuberculosis that affects the spine. It is also called tuberculous spondylitis. The original name was formed after Percival Pott, a London Surgeon. It is most commonly localized in the thoracic region (T9, T10) of the spine.
Causative agent
Mycobacterium tuberculosis
Predisposing factors
• Family history of pulmonary tuberculosis
• Poor environment
• Poor nutrition
• Occupation
• Lack of immunization
Signs and Symptoms
• Back pain
• Fever
• Night sweat
• Anorexia
• Weight loss
• Spinal mass
Diagnostic test
• Increase Erythrocyte Sedimentation Rate- markedly elevated due to inflammation
• Tuberculin skin test (Mantoux test/purified protein derivatives) - this determine whether an individual has been infected with the mycobacterium tuberculosis organism. The test usually consists of an intracutaneous injection of tuberculin, a purified protein derivative of the bacillus.
• Bone biopsy- surgical removal of living body tissue for the study and diagnosis. This is performed to analyze the cause and nature of the disease and on tumors or abnormal tissue growths.
• Radiograph of the spine- to determine the severity or extent of the spinal cord damage.
Medical Management
Chemotherapy
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
Vitamin C, D and B complex
Surgical Management
• Anterior Decompression Spinal Fusion (ADSF)- Best surgical intervention for Pott’s disease.
• Traction and Cast- to immobilize the affected extremities.
• Laminectomy- removal of the ruptured disks in the spine
Nursing Management
• Immobilize the spine
• Provide comfort measures.
• Reposition the patient every 2 hours by the help of other personnel.
• Inspect skin for presence of abscess.
• Increase oral fluid intake
• Encourage the patient to verbalize feelings and concerns.
• Observe for signs of respiratory distress.
• Administer medication as prescribed.
headnursing
PEPTIC ULCER DISEASE
Definition
A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum or esophagus. It is frequently referred to as gastric, duodenal or esophageal ulcer depending on its location. Peptic ulcer is most likely to be in the duodenum than in the stomach. They tend to occur singly, but there maybe several present at one time. Chronic ulcer usually occurs in the lesser curvature of the stomach, near the pylorus.
Predisposing Factors
• Helicobacter pylori
• Chronic use of ASA, NSAID’s (Non steroidal anti-inflammatory drugs), Steroids
• Severe physiologic stress
• Hypersecretory states.
• Cigarette smoking and alcohol intake
• Caffeine, Fatty, spicy, highly acidic foods
• Type O blood
• Genetics
Signs and Symptoms
• Epigastric pain
• Nausea and vomiting
• Dyspepsia (bloating, belching, distention)
• Heart burn
• Chest discomfort
• Anorexia
• Weight loss
• Hematemesis or melena
Medical Management
Medications such as:
Antacids
• Neutralizes HCl
• Taken 1 to 2 hours p. c.
• Examples of drugs are: Amphogel, Basaljel., Milk of magnesia. Maalox (Magnesium based- diarrhea, Aluminum based- constipation)
Histamine (H2) receptor antagonists
• Reduces HCl secretion
• Taken with meals
• Examples are: Zantac (Ranitidine), Pepcid (Famotidine), Axid (Nizatidine), Tagamet (Cimetidine).
Side effects:
• Diarrhea
• Abdominal cramps
• Confusion
• Dizziness
• Weakness
• Cimetidine- antiandrogenic effect (gynecomastia, decrease libido, impotence)
Cytoprotective
• Coats ulcer and increases prostaglandin synthesis
• Taken on an empty stomach (30-60 minutes before meals)
• Example: Carafate (Sucralfate)
Prostaglandin analogue
• Replaces gastric prostaglandin
• Example: Cytotec (Misoprostol)
Proton Pump inhibitor
• Gastric acid secretion inhibitor
• Example : Losec (Omeprazole)
Helicobacter pylori Drug treatment
• Amoxicillin/ tetracycline-Drug of choice
• Flagyl(Metronidazole)
Surgery
Vagotomy
• Resection of vagus nerve
• Decrease cholinergic stimulation
Pyloroplasty
• Surgical dilatation of the pyloric sphincter
• Improves gastric emptying of acidic chime
Antrectomy
• Removal of 50% of the lower part of the stomach
Types:
• Billroth I (Gastroduodenostomy)
• Billroth II (Gastrojejunostomy)
Nursing Management
• Take prescribed medications as ordered
• Diet:
Liberal bland diet during exacerbation
Eat slowly and chew food properly
Small frequent feedings during exacerbation
Avoid fatty foods, coffee, tea, cola drinks, chocolate, spices, red/black pepper, alcohol.
• Quit smoking
• Stress therapy
• Regular pattern of exercise
Differentiation between Gastric and Duodenal Ulcer
Gasric Ulcer
• Poor Man’s ulcer/laborer’s ulcer
• 20% incidence
• 50 years old and above
• Malnourished
• Normal gastric secretions and normal emptying rate
• Radiates to left
• Pain appears ½ to 2 hours p. c.
• Do not relieved by food
• Nausea and vomiting, hematemesis are common
• Complications are:
Hemorrhage
Perforation
Peritonitis
Duodenal Ulcer
• Executive’s ulcer
• 80% incidence
• 25-50 years old
• Well-nourished
• Over secretions of Hydrochloric acid
• Radiates to right
• Pain appears 3 to 4 hours p. c.
• Relieved by food
• Melena is more common
• Complications are:
Obstruction
Hemorrhage
Perforation
Peritonitis
Definition
A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum or esophagus. It is frequently referred to as gastric, duodenal or esophageal ulcer depending on its location. Peptic ulcer is most likely to be in the duodenum than in the stomach. They tend to occur singly, but there maybe several present at one time. Chronic ulcer usually occurs in the lesser curvature of the stomach, near the pylorus.
Predisposing Factors
• Helicobacter pylori
• Chronic use of ASA, NSAID’s (Non steroidal anti-inflammatory drugs), Steroids
• Severe physiologic stress
• Hypersecretory states.
• Cigarette smoking and alcohol intake
• Caffeine, Fatty, spicy, highly acidic foods
• Type O blood
• Genetics
Signs and Symptoms
• Epigastric pain
• Nausea and vomiting
• Dyspepsia (bloating, belching, distention)
• Heart burn
• Chest discomfort
• Anorexia
• Weight loss
• Hematemesis or melena
Medical Management
Medications such as:
Antacids
• Neutralizes HCl
• Taken 1 to 2 hours p. c.
• Examples of drugs are: Amphogel, Basaljel., Milk of magnesia. Maalox (Magnesium based- diarrhea, Aluminum based- constipation)
Histamine (H2) receptor antagonists
• Reduces HCl secretion
• Taken with meals
• Examples are: Zantac (Ranitidine), Pepcid (Famotidine), Axid (Nizatidine), Tagamet (Cimetidine).
Side effects:
• Diarrhea
• Abdominal cramps
• Confusion
• Dizziness
• Weakness
• Cimetidine- antiandrogenic effect (gynecomastia, decrease libido, impotence)
Cytoprotective
• Coats ulcer and increases prostaglandin synthesis
• Taken on an empty stomach (30-60 minutes before meals)
• Example: Carafate (Sucralfate)
Prostaglandin analogue
• Replaces gastric prostaglandin
• Example: Cytotec (Misoprostol)
Proton Pump inhibitor
• Gastric acid secretion inhibitor
• Example : Losec (Omeprazole)
Helicobacter pylori Drug treatment
• Amoxicillin/ tetracycline-Drug of choice
• Flagyl(Metronidazole)
Surgery
Vagotomy
• Resection of vagus nerve
• Decrease cholinergic stimulation
Pyloroplasty
• Surgical dilatation of the pyloric sphincter
• Improves gastric emptying of acidic chime
Antrectomy
• Removal of 50% of the lower part of the stomach
Types:
• Billroth I (Gastroduodenostomy)
• Billroth II (Gastrojejunostomy)
Nursing Management
• Take prescribed medications as ordered
• Diet:
Liberal bland diet during exacerbation
Eat slowly and chew food properly
Small frequent feedings during exacerbation
Avoid fatty foods, coffee, tea, cola drinks, chocolate, spices, red/black pepper, alcohol.
• Quit smoking
• Stress therapy
• Regular pattern of exercise
Differentiation between Gastric and Duodenal Ulcer
Gasric Ulcer
• Poor Man’s ulcer/laborer’s ulcer
• 20% incidence
• 50 years old and above
• Malnourished
• Normal gastric secretions and normal emptying rate
• Radiates to left
• Pain appears ½ to 2 hours p. c.
• Do not relieved by food
• Nausea and vomiting, hematemesis are common
• Complications are:
Hemorrhage
Perforation
Peritonitis
Duodenal Ulcer
• Executive’s ulcer
• 80% incidence
• 25-50 years old
• Well-nourished
• Over secretions of Hydrochloric acid
• Radiates to right
• Pain appears 3 to 4 hours p. c.
• Relieved by food
• Melena is more common
• Complications are:
Obstruction
Hemorrhage
Perforation
Peritonitis
Saturday, February 7, 2009
sunshine M.
BRIEF HISTORY OF “THE SUNSHINE”
“ANG SINAG”
The campus paper Sinag was a product of perseverance and willingness to give information to every student.
Due to this willingness, Miss Rosario Bernardo, Miss Teresita Torio, Miss Annaliza Torres, and Miss Florence Datuin created the “Sinag” or “The Sunshine” in the year 1995.
It was the campus paper of Eduardo L. Joson Memorial High school.
It was a magazine size campus paper with 8 pages, having an article written in English and Filipino language. In every school year, they produce 500 copies given for every student.
The process of production was assisted by the printing press a dummy was sent to them. It cost 50 pesos per campus paper. Until now, the “Sunshine” publication still shines.
BASIC INFORMATION
The size of the paper being use was 12 x 18 for contest entry but in regular issue, they produce a magazine size. In every, production they always make sure that the magazine is composed of 8 pages. 1,000 copies were produce in every production. It was produced two times in a school year in order to inform the students what was happening in the school. They are using a glossy type of paper with an ADOBE page maker for every printing. Now the “THE SUNSHINE” causes 90 pesos per copy.
MAN POWER/HUMAN RESOURCES
From the two advisers, Mrs. Crispina S. Bravo and Mrs. Mylene R. Alviar down to the Editor-in-chief, Associate editor, Feature editor, News editor and sports editor, the division of labor was distributed.
The editor and staff wrote the articles, and then the advisers will be the one to suggest if there is something to change or something to be added, and then approve it.
The advisers also supervise the staff and serve as a coach in the press conferences. They also serve as manager for releasing funds for the paper.
The school administrator serves as a consultant of the publication. The Parents-Teachers Association (PTA) serves as one of the great supporter of the publication.
WORK PROCESS
Work process was distributed to the top position up to the last.
For gathering information, all of the staff uses their seeking power to gather different information. The News editor, Feature writer and the Editor-in-chief were the one responsible for writing an article about the said information they have gathered.
In editing the articles, the copy reader is the one who’s responsible for it. In laying out pages, the editor-in-chief was assigned to do this.
The printing press has the role in the printing process of the materials. The distributions of copies were the responsibility of the staff and teachers.
OTHER ACTIVITIES
The staffs of “The Sunshine” attended different press conferences and seminars. Last September, 2006, they have attended the Regional Training for School paper advisers and journalist held at Talavera Central School. Last August, 2007, they have attended the same workshop seminar at Subic, Zambales.
Last October 14, 2008, they did attend the School District Level Press Conference held at Zaragosa National High School. On November, 2006, they attended the District Level Press Conference held at Talavera Central School. Last November, 2007, they have attended again the same Division Level Press Conference (DSPC) at same place.
“ANG SINAG”
The campus paper Sinag was a product of perseverance and willingness to give information to every student.
Due to this willingness, Miss Rosario Bernardo, Miss Teresita Torio, Miss Annaliza Torres, and Miss Florence Datuin created the “Sinag” or “The Sunshine” in the year 1995.
It was the campus paper of Eduardo L. Joson Memorial High school.
It was a magazine size campus paper with 8 pages, having an article written in English and Filipino language. In every school year, they produce 500 copies given for every student.
The process of production was assisted by the printing press a dummy was sent to them. It cost 50 pesos per campus paper. Until now, the “Sunshine” publication still shines.
BASIC INFORMATION
The size of the paper being use was 12 x 18 for contest entry but in regular issue, they produce a magazine size. In every, production they always make sure that the magazine is composed of 8 pages. 1,000 copies were produce in every production. It was produced two times in a school year in order to inform the students what was happening in the school. They are using a glossy type of paper with an ADOBE page maker for every printing. Now the “THE SUNSHINE” causes 90 pesos per copy.
MAN POWER/HUMAN RESOURCES
From the two advisers, Mrs. Crispina S. Bravo and Mrs. Mylene R. Alviar down to the Editor-in-chief, Associate editor, Feature editor, News editor and sports editor, the division of labor was distributed.
The editor and staff wrote the articles, and then the advisers will be the one to suggest if there is something to change or something to be added, and then approve it.
The advisers also supervise the staff and serve as a coach in the press conferences. They also serve as manager for releasing funds for the paper.
The school administrator serves as a consultant of the publication. The Parents-Teachers Association (PTA) serves as one of the great supporter of the publication.
WORK PROCESS
Work process was distributed to the top position up to the last.
For gathering information, all of the staff uses their seeking power to gather different information. The News editor, Feature writer and the Editor-in-chief were the one responsible for writing an article about the said information they have gathered.
In editing the articles, the copy reader is the one who’s responsible for it. In laying out pages, the editor-in-chief was assigned to do this.
The printing press has the role in the printing process of the materials. The distributions of copies were the responsibility of the staff and teachers.
OTHER ACTIVITIES
The staffs of “The Sunshine” attended different press conferences and seminars. Last September, 2006, they have attended the Regional Training for School paper advisers and journalist held at Talavera Central School. Last August, 2007, they have attended the same workshop seminar at Subic, Zambales.
Last October 14, 2008, they did attend the School District Level Press Conference held at Zaragosa National High School. On November, 2006, they attended the District Level Press Conference held at Talavera Central School. Last November, 2007, they have attended again the same Division Level Press Conference (DSPC) at same place.
Tuesday, February 3, 2009
ncp
IV. NURSING CARE PLAN
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
1. dyspnea
2. coughing
3. cyanosis
4. tachypnea
Ineffective breathing pattern related to increased work of breathing.
At the end of 8 hours of duty, the patient will be able to know how to deal with the situation and lessen the respiratory distress being experienced.
Assess respiratory status when the patient is calm. A minimum of every 2-4 hours or more often as indicated for an increasing or decreasing respiratory rate and episodes of apnea.
Administer humidified oxygen via mask, nasal cannula, hood, or tent
Assess pulse oximetry on room air and compare to reading when child is on oxygen.
Note patient’s response to ordered medications.
Position head of the bed up or place child in position of comfort.
Changes in breathing pattern may occur quickly as the patient’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Humidified oxygen loosens secretions, helps maintain oxygenation status and eases respiratory distress.
Comparison of pulse oximetry readings provides information about improvement status.
Medications act systematically to improve oxygenation and decrease inflammation.
Position facilitates improved aeration and promotes decrease in anxiety and energy expenditures.
At the end of 8 hours of duty, the patient displayed understanding about her condition and learned how to lessen the distress that she experienced.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Anorexia
Decrease oral fluid intake
Risk for deficient fluid volume related to inability to meet body requirements and increased metabolic demand.
At the end of 8 hours of duty, the patient will be able to correct the fluid deficit, adequately hydrated, be able to tolerate oral fluids and progress to normal diet.
Evaluate need for intravenous fluids. Maintain IV as ordered.
Calculate maintenance fluid requirements and give oral fluids, IV fluids or both.
Maintain strict intake and output monitoring and evaluate specific gravity at least 8 hours.
Perform daily weight measurement on the same scale at the same time of the day. Evaluate skin turgor.
Assess mucous membranes. Report changes promptly to the physician.
Offer clear fluids chosen by the patient when tolerated.
Previous fluid loss may require immediate replacement.
Assessment ensures
Patient receives appropriate fluids to maintain hydration while transitioning to oral fluids.
Monitoring provides objective evidence of fluid loss and ongoing hydration status.
Further evidence of improvement of hydration status.
Moist mucous membranes provide observable evidence of hydration.
Choice of fluid offered gains the patient’s cooperation.
At the end of 8 hours of duty, the patient was corrected the fluid deficit, hydration is in normal and tolerated the food given.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Irritability/ uneasiness
Quietness
apprehensive
Anxiety related to acute illness, hospitalization, uncertain course of illness and treatment and home care needs.
At the end of 8 hours of duty, the patient will be able to verbalize feelings and discomfort and demonstrate behaviors that indicate decrease in anxiety.
Encourage patient to express fears and ask questions; provide direct answers and discuss care, procedures and condition changes.
Explain symptoms, treatment and home care management of COPD.
Provides opportunity to vent feelings and receive timely, relevant information. Establish rapport to gain trust of the patient.
Anticipate potential for recurrence. Assist patient to be prepared about recurrence of the disease after discharge.
At the end of 8 hours of duty, the patient verbalized feelings and discomfort and demonstrated behaviors that indicate decreased anxiety.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Request for information
Statements of misconceptions
Knowledge deficit regarding condition, prognosis, treatment, self care, and discharge needs related to information misinterpretation.
At the end of 8 hours of duty, the patient will be able to verbalize understanding about the disease process and participate in treatment regimen.
Determine patient’s perception of the disease process.
Review disease process, cause and effect relationship factors that precipitate symptoms and identify ways to reduce contributing factors. Encourage questions.
Review medications, purpose, frequency, dosage and possible side effects.
Remind patient to observe for side effects if steroids are given on long term basis (ulcers, facial edema and muscle weakness).
Stress importance of proper hand washing techniques.
Establishes knowledge base and provides some insight into individual learning needs.
Precipitating or aggravating factors are individual; therefore the patient needs to be aware of what foods, fluids and lifestyle factors can precipitate symptoms. Accurate knowledge base provides opportunities for patient to make informed decisions and choices about future and control of chronic disease. Although most patients know about their own disease process, they may have outdated information or misconceptions.
Promotes understanding and may enhance cooperation with regimen.
Steroids may be used to control inflammation and to effect a remission of the disease; however, drug may lower resistance to infection and cause fluid retention.
Reduces spread of bacteria
At the end of 8 hours of duty, the patient verbalized understanding about the disease process and participating in the treatment regimen.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
1. dyspnea
2. coughing
3. cyanosis
4. tachypnea
Ineffective breathing pattern related to increased work of breathing.
At the end of 8 hours of duty, the patient will be able to know how to deal with the situation and lessen the respiratory distress being experienced.
Assess respiratory status when the patient is calm. A minimum of every 2-4 hours or more often as indicated for an increasing or decreasing respiratory rate and episodes of apnea.
Administer humidified oxygen via mask, nasal cannula, hood, or tent
Assess pulse oximetry on room air and compare to reading when child is on oxygen.
Note patient’s response to ordered medications.
Position head of the bed up or place child in position of comfort.
Changes in breathing pattern may occur quickly as the patient’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Humidified oxygen loosens secretions, helps maintain oxygenation status and eases respiratory distress.
Comparison of pulse oximetry readings provides information about improvement status.
Medications act systematically to improve oxygenation and decrease inflammation.
Position facilitates improved aeration and promotes decrease in anxiety and energy expenditures.
At the end of 8 hours of duty, the patient displayed understanding about her condition and learned how to lessen the distress that she experienced.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Anorexia
Decrease oral fluid intake
Risk for deficient fluid volume related to inability to meet body requirements and increased metabolic demand.
At the end of 8 hours of duty, the patient will be able to correct the fluid deficit, adequately hydrated, be able to tolerate oral fluids and progress to normal diet.
Evaluate need for intravenous fluids. Maintain IV as ordered.
Calculate maintenance fluid requirements and give oral fluids, IV fluids or both.
Maintain strict intake and output monitoring and evaluate specific gravity at least 8 hours.
Perform daily weight measurement on the same scale at the same time of the day. Evaluate skin turgor.
Assess mucous membranes. Report changes promptly to the physician.
Offer clear fluids chosen by the patient when tolerated.
Previous fluid loss may require immediate replacement.
Assessment ensures
Patient receives appropriate fluids to maintain hydration while transitioning to oral fluids.
Monitoring provides objective evidence of fluid loss and ongoing hydration status.
Further evidence of improvement of hydration status.
Moist mucous membranes provide observable evidence of hydration.
Choice of fluid offered gains the patient’s cooperation.
At the end of 8 hours of duty, the patient was corrected the fluid deficit, hydration is in normal and tolerated the food given.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Irritability/ uneasiness
Quietness
apprehensive
Anxiety related to acute illness, hospitalization, uncertain course of illness and treatment and home care needs.
At the end of 8 hours of duty, the patient will be able to verbalize feelings and discomfort and demonstrate behaviors that indicate decrease in anxiety.
Encourage patient to express fears and ask questions; provide direct answers and discuss care, procedures and condition changes.
Explain symptoms, treatment and home care management of COPD.
Provides opportunity to vent feelings and receive timely, relevant information. Establish rapport to gain trust of the patient.
Anticipate potential for recurrence. Assist patient to be prepared about recurrence of the disease after discharge.
At the end of 8 hours of duty, the patient verbalized feelings and discomfort and demonstrated behaviors that indicate decreased anxiety.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Request for information
Statements of misconceptions
Knowledge deficit regarding condition, prognosis, treatment, self care, and discharge needs related to information misinterpretation.
At the end of 8 hours of duty, the patient will be able to verbalize understanding about the disease process and participate in treatment regimen.
Determine patient’s perception of the disease process.
Review disease process, cause and effect relationship factors that precipitate symptoms and identify ways to reduce contributing factors. Encourage questions.
Review medications, purpose, frequency, dosage and possible side effects.
Remind patient to observe for side effects if steroids are given on long term basis (ulcers, facial edema and muscle weakness).
Stress importance of proper hand washing techniques.
Establishes knowledge base and provides some insight into individual learning needs.
Precipitating or aggravating factors are individual; therefore the patient needs to be aware of what foods, fluids and lifestyle factors can precipitate symptoms. Accurate knowledge base provides opportunities for patient to make informed decisions and choices about future and control of chronic disease. Although most patients know about their own disease process, they may have outdated information or misconceptions.
Promotes understanding and may enhance cooperation with regimen.
Steroids may be used to control inflammation and to effect a remission of the disease; however, drug may lower resistance to infection and cause fluid retention.
Reduces spread of bacteria
At the end of 8 hours of duty, the patient verbalized understanding about the disease process and participating in the treatment regimen.
ncp
IV. NURSING CARE PLAN
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
1. dyspnea
2. coughing
3. cyanosis
4. tachypnea
Ineffective breathing pattern related to increased work of breathing.
At the end of 8 hours of duty, the patient will be able to know how to deal with the situation and lessen the respiratory distress being experienced.
Assess respiratory status when the patient is calm. A minimum of every 2-4 hours or more often as indicated for an increasing or decreasing respiratory rate and episodes of apnea.
Administer humidified oxygen via mask, nasal cannula, hood, or tent
Assess pulse oximetry on room air and compare to reading when child is on oxygen.
Note patient’s response to ordered medications.
Position head of the bed up or place child in position of comfort.
Changes in breathing pattern may occur quickly as the patient’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Humidified oxygen loosens secretions, helps maintain oxygenation status and eases respiratory distress.
Comparison of pulse oximetry readings provides information about improvement status.
Medications act systematically to improve oxygenation and decrease inflammation.
Position facilitates improved aeration and promotes decrease in anxiety and energy expenditures.
At the end of 8 hours of duty, the patient displayed understanding about her condition and learned how to lessen the distress that she experienced.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Anorexia
Decrease oral fluid intake
Risk for deficient fluid volume related to inability to meet body requirements and increased metabolic demand.
At the end of 8 hours of duty, the patient will be able to correct the fluid deficit, adequately hydrated, be able to tolerate oral fluids and progress to normal diet.
Evaluate need for intravenous fluids. Maintain IV as ordered.
Calculate maintenance fluid requirements and give oral fluids, IV fluids or both.
Maintain strict intake and output monitoring and evaluate specific gravity at least 8 hours.
Perform daily weight measurement on the same scale at the same time of the day. Evaluate skin turgor.
Assess mucous membranes. Report changes promptly to the physician.
Offer clear fluids chosen by the patient when tolerated.
Previous fluid loss may require immediate replacement.
Assessment ensures
Patient receives appropriate fluids to maintain hydration while transitioning to oral fluids.
Monitoring provides objective evidence of fluid loss and ongoing hydration status.
Further evidence of improvement of hydration status.
Moist mucous membranes provide observable evidence of hydration.
Choice of fluid offered gains the patient’s cooperation.
At the end of 8 hours of duty, the patient was corrected the fluid deficit, hydration is in normal and tolerated the food given.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Irritability/ uneasiness
Quietness
apprehensive
Anxiety related to acute illness, hospitalization, uncertain course of illness and treatment and home care needs.
At the end of 8 hours of duty, the patient will be able to verbalize feelings and discomfort and demonstrate behaviors that indicate decrease in anxiety.
Encourage patient to express fears and ask questions; provide direct answers and discuss care, procedures and condition changes.
Explain symptoms, treatment and home care management of COPD.
Provides opportunity to vent feelings and receive timely, relevant information. Establish rapport to gain trust of the patient.
Anticipate potential for recurrence. Assist patient to be prepared about recurrence of the disease after discharge.
At the end of 8 hours of duty, the patient verbalized feelings and discomfort and demonstrated behaviors that indicate decreased anxiety.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Request for information
Statements of misconceptions
Knowledge deficit regarding condition, prognosis, treatment, self care, and discharge needs related to information misinterpretation.
At the end of 8 hours of duty, the patient will be able to verbalize understanding about the disease process and participate in treatment regimen.
Determine patient’s perception of the disease process.
Review disease process, cause and effect relationship factors that precipitate symptoms and identify ways to reduce contributing factors. Encourage questions.
Review medications, purpose, frequency, dosage and possible side effects.
Remind patient to observe for side effects if steroids are given on long term basis (ulcers, facial edema and muscle weakness).
Stress importance of proper hand washing techniques.
Establishes knowledge base and provides some insight into individual learning needs.
Precipitating or aggravating factors are individual; therefore the patient needs to be aware of what foods, fluids and lifestyle factors can precipitate symptoms. Accurate knowledge base provides opportunities for patient to make informed decisions and choices about future and control of chronic disease. Although most patients know about their own disease process, they may have outdated information or misconceptions.
Promotes understanding and may enhance cooperation with regimen.
Steroids may be used to control inflammation and to effect a remission of the disease; however, drug may lower resistance to infection and cause fluid retention.
Reduces spread of bacteria
At the end of 8 hours of duty, the patient verbalized understanding about the disease process and participating in the treatment regimen.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
1. dyspnea
2. coughing
3. cyanosis
4. tachypnea
Ineffective breathing pattern related to increased work of breathing.
At the end of 8 hours of duty, the patient will be able to know how to deal with the situation and lessen the respiratory distress being experienced.
Assess respiratory status when the patient is calm. A minimum of every 2-4 hours or more often as indicated for an increasing or decreasing respiratory rate and episodes of apnea.
Administer humidified oxygen via mask, nasal cannula, hood, or tent
Assess pulse oximetry on room air and compare to reading when child is on oxygen.
Note patient’s response to ordered medications.
Position head of the bed up or place child in position of comfort.
Changes in breathing pattern may occur quickly as the patient’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Humidified oxygen loosens secretions, helps maintain oxygenation status and eases respiratory distress.
Comparison of pulse oximetry readings provides information about improvement status.
Medications act systematically to improve oxygenation and decrease inflammation.
Position facilitates improved aeration and promotes decrease in anxiety and energy expenditures.
At the end of 8 hours of duty, the patient displayed understanding about her condition and learned how to lessen the distress that she experienced.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Anorexia
Decrease oral fluid intake
Risk for deficient fluid volume related to inability to meet body requirements and increased metabolic demand.
At the end of 8 hours of duty, the patient will be able to correct the fluid deficit, adequately hydrated, be able to tolerate oral fluids and progress to normal diet.
Evaluate need for intravenous fluids. Maintain IV as ordered.
Calculate maintenance fluid requirements and give oral fluids, IV fluids or both.
Maintain strict intake and output monitoring and evaluate specific gravity at least 8 hours.
Perform daily weight measurement on the same scale at the same time of the day. Evaluate skin turgor.
Assess mucous membranes. Report changes promptly to the physician.
Offer clear fluids chosen by the patient when tolerated.
Previous fluid loss may require immediate replacement.
Assessment ensures
Patient receives appropriate fluids to maintain hydration while transitioning to oral fluids.
Monitoring provides objective evidence of fluid loss and ongoing hydration status.
Further evidence of improvement of hydration status.
Moist mucous membranes provide observable evidence of hydration.
Choice of fluid offered gains the patient’s cooperation.
At the end of 8 hours of duty, the patient was corrected the fluid deficit, hydration is in normal and tolerated the food given.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Irritability/ uneasiness
Quietness
apprehensive
Anxiety related to acute illness, hospitalization, uncertain course of illness and treatment and home care needs.
At the end of 8 hours of duty, the patient will be able to verbalize feelings and discomfort and demonstrate behaviors that indicate decrease in anxiety.
Encourage patient to express fears and ask questions; provide direct answers and discuss care, procedures and condition changes.
Explain symptoms, treatment and home care management of COPD.
Provides opportunity to vent feelings and receive timely, relevant information. Establish rapport to gain trust of the patient.
Anticipate potential for recurrence. Assist patient to be prepared about recurrence of the disease after discharge.
At the end of 8 hours of duty, the patient verbalized feelings and discomfort and demonstrated behaviors that indicate decreased anxiety.
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Request for information
Statements of misconceptions
Knowledge deficit regarding condition, prognosis, treatment, self care, and discharge needs related to information misinterpretation.
At the end of 8 hours of duty, the patient will be able to verbalize understanding about the disease process and participate in treatment regimen.
Determine patient’s perception of the disease process.
Review disease process, cause and effect relationship factors that precipitate symptoms and identify ways to reduce contributing factors. Encourage questions.
Review medications, purpose, frequency, dosage and possible side effects.
Remind patient to observe for side effects if steroids are given on long term basis (ulcers, facial edema and muscle weakness).
Stress importance of proper hand washing techniques.
Establishes knowledge base and provides some insight into individual learning needs.
Precipitating or aggravating factors are individual; therefore the patient needs to be aware of what foods, fluids and lifestyle factors can precipitate symptoms. Accurate knowledge base provides opportunities for patient to make informed decisions and choices about future and control of chronic disease. Although most patients know about their own disease process, they may have outdated information or misconceptions.
Promotes understanding and may enhance cooperation with regimen.
Steroids may be used to control inflammation and to effect a remission of the disease; however, drug may lower resistance to infection and cause fluid retention.
Reduces spread of bacteria
At the end of 8 hours of duty, the patient verbalized understanding about the disease process and participating in the treatment regimen.
study
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
1. dyspnea
2. coughing
3. cyanosis
4. tachypnea
Ineffective breathing pattern related to increased work of breathing.
At the end of 8 hours of duty, the patient will be able to know how to deal with the situation and lessen the respiratory distress being experienced.
Assess respiratory status when the patient is calm. A minimum of every 2-4 hours or more often as indicated for an increasing or decreasing respiratory rate and episodes of apnea.
Administer humidified oxygen via mask, nasal cannula, hood, or tent
Assess pulse oximetry on room air and compare to reading when child is on oxygen.
Note patient’s response to ordered medications.
Position head of the bed up or place child in position of comfort.
Changes in breathing pattern may occur quickly as the patient’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Humidified oxygen loosens secretions, helps maintain oxygenation status and eases respiratory distress.
Comparison of pulse oximetry readings provides information about improvement status.
Medications act systematically to improve oxygenation and decrease inflammation.
Position facilitates improved aeration and promotes decrease in anxiety and energy expenditures.
At the end of 8 hours of duty, the patient displayed understanding about her condition and learned how to lessen the distress that she experienced.
1. dyspnea
2. coughing
3. cyanosis
4. tachypnea
Ineffective breathing pattern related to increased work of breathing.
At the end of 8 hours of duty, the patient will be able to know how to deal with the situation and lessen the respiratory distress being experienced.
Assess respiratory status when the patient is calm. A minimum of every 2-4 hours or more often as indicated for an increasing or decreasing respiratory rate and episodes of apnea.
Administer humidified oxygen via mask, nasal cannula, hood, or tent
Assess pulse oximetry on room air and compare to reading when child is on oxygen.
Note patient’s response to ordered medications.
Position head of the bed up or place child in position of comfort.
Changes in breathing pattern may occur quickly as the patient’s energy reserves are depleted. Assessment and monitoring baseline reveal rate and quality of air exchange. Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Humidified oxygen loosens secretions, helps maintain oxygenation status and eases respiratory distress.
Comparison of pulse oximetry readings provides information about improvement status.
Medications act systematically to improve oxygenation and decrease inflammation.
Position facilitates improved aeration and promotes decrease in anxiety and energy expenditures.
At the end of 8 hours of duty, the patient displayed understanding about her condition and learned how to lessen the distress that she experienced.
case
Nueva Ecija University of Science and Technology
College of Nursing
General Tinio Street, Cabanatuan City
A
CASE STUDY
ABOUT
“CHRONIC OBSTRUCTIVE PULMONARY DISEASE’’
Submitted by:
Karen Katrin M. Tabunan
Ayra A. Susada
Glenda Marie D. Tadiaman
Verlinda Sampana
Lou Arden Sermonia
BSN IV-J Submitted to:
Ms. Ria May R. Velasco
Ms. Gisharmaine Turner
Head Nursing
Mrs. Loida Martinez
Clinical Instructor
I. INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a disease state in which airflow is obstructed by emphysema, chronic bronchitis or both. The airflow obstruction is usually progressive, irreversible, and associated with airway hyperactivity resulting in narrowing of peripheral airways, airway flow limitation and changes in the pulmonary vasculature. Asthma now is considered as a separate disorder overlaps with symptoms of COPD. Cigarette smoking, air pollution and occupational exposure (coal, cotton and grain) are important risk factors that contribute to its development, which may occur over a 20-30 year span. Complications of COPD vary but include respiratory insufficiency and failure (major complication) as well as pneumonia, atelectasis and pneumothorax.
II. OBJECTIVES
GENERAL OBJECTIVES
After the 32 hours of duty at the Gapan District Hospital General Ward, we will be able:
• To provide a quality nursing care for the patient with chronic obstructive pulmonary disease,
• To impart our knowledge and skills in dealing with patient’s case, and
• To enhanced more our skill in doing our actual nurse nurse-patient interaction.
SPECIFIC OBJECTIVES
A. CLIENT CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the patient will be able:
• To verbalized feelings and concerns about her condition,
• To participate in the activities needed in the conduction of this case, and
• To cope with her situation and live like in a normal condition.
B. NURSE CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the students will be able:
• To gain the trust of the patient to make her cooperative with the activities being conducted,
• To acquire/learned more knowledge about the disease process, its manifestation, medical management and the nursing responsibilities needed in dealing with the patient, and
• To impart knowledge to the patient that she will use in her daily living.
III. CASE DISCUSSION
III.1 DEFINITION
Chronic obstructive pulmonary disease is a group of disorders that affect the movement of air in and out the lungs.
TYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
• Chronic Bronchitis
• Emphysema
• Bronchiectasis
CHRONIC BRONCHITIS (BLUE BLOATERS)
Chronic Bronchitis is defined as a productive cough that lasts 3 months a year for 2 consecutive years with other causes excluded. Chronic exposure to smoke or another pollutant irritates the airways resulting in hypersecretion of mucus and inflammation, thickened bronchial walls and narrow bronchial lumen. Patients have increased susceptibility to recurring infections of the lower respiratory tract.
CLINICAL MANIFESTATIONS
a. Chronic, productive cough with copious sputum in winter months.
b. Earliest sign: cough is exacerbated by cold weather, dampness and pulmonary irritants
c. Dyspnea on exertion
d. Rales/ronchi
e. Cyanosis
RISK FACTORS
a. Cigarette smoking
b. Exposure to pollution or hazardous airborne substances
c. Heredity/family history
d. Frequent respiratory infections
EMPHYSEMA (PINK PUFFERS)
Emphysema is defined as a non uniform pattern of abnormal, permanent distention of the air spaces with destruction of the alveolar walls and eventually a reduced pulmonary capillary bed. The main problem with this disease is the loss of elasticity which eventually leads to a state of CO² retention, hypoxia and respiratory acidosis.
CLINICAL MANIFESTATIONS
a. Dyspnea on exertion
b. Cough and sputum
c. Signs of respiratory distress
d. Fatigue
e. Weight loss
f. Hyper resonance on percussion
RISK FACTORS
a. cigarette smoking
b. infection
c. inhaled irritants
d. heredity
e. allergic factors
BRONCHIECTASIS
Bronchiectasis is a chronic irreversible dilatation and impaired mucociliary clearance of the bronchi and bronchioles. The result is retention of the secretions, obstructions and eventually alveolar collapse.
CLINICAL MANIFESTATIONS
a. chronic cough with sputum
b. hemoptysis
c. dyspnea
d. wheezing
e. fatigue
f. weight loss
g. fever
RISK FACTORS
a. recurrent lower respiratory tract infection
b. congenital defects
c. bronchial tumors
III.2 MEDICAL MANAGEMENT
a. Bronchodilators- any of a group of drugs that expand the air passages (bronchial tubes) of the lungs. Bronchodilators are used to treat asthma, bronchitis, emphysema, and other diseases that affect the lungs. They relieve symptoms such as wheezing, shortness of breath, and coughing, and restore the patient’s ability to breathe comfortably.
b. Oxygen therapy in low concentrations- essential for cells, which use this vital substance to liberate the energy needed for cellular activities.
c. Anti- microbial therapy with sputum culture and sensitivity studies- for the minimization of microorganisms invading the respiratory tract of the patient.
d. Prophylactic vaccination- used for the prevention of further complication like pneumonia and influenza.
e. Chest physiotherapy with percussion; postural drainage, expectorations or broncoscopy to remove bronchial secretions.
f. Increased oral fluid intake
PREVENTION
a. Smoking cessation
b. Minimizing exposure to pollutions and irritants
III.3 COLLABORATIVE PROBLEMS and its NURSING MANAGEMENT
a. Respiratory insufficiency or failure
b. Pneumonia
c. Pneumothorax
d. Pulmonary hypertension
a. RESPIRATORY INSUFFICIENCY/FAILURE
Respiratory insufficiency/ failure occur when the body can no longer maintain effective gas exchange. The physiologic process that ends in respiratory failure begins with hypoventilation of the alveoli. Hypoventilation occurs when the body’s need for oxygen exceeds actual oxygen intake, the airway is partially occluded or the transfer of oxygen and carbon dioxide in the alveolar is disrupted. This disruption may occur either because of malfunction of respiratory center stimulation or because the alveolar membrane is defective.
CLINICAL MANIFESTATIONS
a. irritability
b. lethargy
c. cyanosis
d. dyspnea
e. tachypnea
f. nasal flaring
g. intercostals retractions
h. Respiratory grunting which slows the expiratory flow and increases the lung volume and alveolar pressure (signs of severe disease and suggest onset of respiratory failure).
NURSING MANAGEMENT
a. Assess patient’s quality of respiration and rate, apical pulse and temperature
b. Monitor oxygen saturation with pulse oximetry
c. Place the patient in an upright position
d. Administer oxygen as ordered
e. Keep emergency respiratory equipment at bedside
f. Monitor for the level of consciousness
b. PNEUMONIA
Pneumonia is an inflammation of the lung parenchyma commonly caused by microbial agents. Pneumonia may be viral, bacterial, or mycoplasmal in origin. Those at risk for pneumonia often have chronic underlying disorders, severe acute illness, a suppressed immune system from disease or medications, immobility, and other factors that interfere with normal lung protective mechanisms.
CLINICAL MANIFESTATIONS
a. sudden chills, rapidly rising fever (38.5°C to 40.5°C) with profuse perspiration
b. Pleuritic chest pain aggravated by respiration and coughing
c. Severely ill patient has marked tachypnea (25-45 breaths/minute) and dyspnea; orthopnea when not propped up
d. Pulse is rapid and bounding; may increase 10 beats/minute per degree of temperature elevation (Celsius)
e. A relative bradycardia for the amount of fever suggests viral infections or mycoplasma or legionella species infections.
f. Sputum purulent, rusty, bloody-tinged, viscous or green depending in etiologic agent.
g. Other sign include crackles, and signs of lobar consolidation; initial upper respiratory tract symptoms (nasal congestion, sore throat).
h. Severe pneumonia: flushed cheeks: lips and nail beds demonstrating central cyanosis.
NURSING MANAGEMENT
a. Instruct the patient about chest splinting by hugging pillow to make coughing and breathing less painful.
b. Administer medications as prescribed by the physician.
c. Instruct the patient when an antibiotic is being given; make sure that it will be taken as full course at prescribed intervals.
d. Teach patient the proper administration of drugs and any side effects.
e. Teach the proper disposal of tissue being used by the patient to prevent the spread of microorganisms.
c. PNEUMOTHORAX
Pneumothorax occurs when the parietal or visceral pleura are breached and the pleural space is exposed to positive atmospheric pressure. Air enters the pleural space and a lung or portion of it collapses.
CLINICAL MANIFESTATIONS
a. Pleuritic pain
b. Minimal respiratory distress with small pneumothorax; acute respiratory distress if large
c. Anxiety, dyspnea, air hunger, use of accessory muscles and central cyanosis with severe hypoxemia, accompanied by tachypnea
d. Tympanic sound on percussion of the chess wall
e. Decreased or absence of breath sounds and tactile fremitus on affected side.
NURSING MANAGEMENT
a. Monitor blood oxygen level using pulse oximetry in case of hypoxia
b. Assist in chest tube insertion; maintain chest drainage or water seal.
c. Monitor respiratory status
d. Provide emotional support to the patient.
d. PULMONARY HYPERTENSION
Pulmonary hypertension is a condition that is not clinically evident until late in the disease. The systolic pulmonary arterial pressure exceeds 30 mmHg, and the mean pulmonary artery pressure is higher than 25 mmHg.
CLINICAL MANIFESTATIONS
a. Dyspnea, the main symptom, is noticed first with exacerbation and then at rest.
b. Substernal chest pain is common 25% to 50% of patients.
c. Weakness, fatigability, syncope, and occasional hemoptysis may occur
d. Signs of right sided heart failure are noted (peripheral edema, ascites, distended neck veins, liver engorgement, crackles and heart murmur).
e. ECG changes (right ventricular hypertrophy) are seen, with right axis deviation and tall peaked P waves in inferior leads and tall anterior R waves and ST segment depression or T wave inversion anteriorly.
f. PaO2 is decreased (hypoxemia).
NURSING MANAGEMENT
a. Administer prescribed oxygen therapy appropriately.
b. Be alert for signs and symptoms of the disease.
c. Prepare the emergency life saving device at bedside of the patient.
d. Administer medication as prescribed.
e. Monitor fluid intake and output carefully.
f. Promote rest for oxygen conservation.
g. Tailored sitting exercise to avoid dyspnea.
V. DISCHARGE PLANNING
1. Recommend the patient adopt a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity.
2. Demonstrate and supervise patient and family in performing all aspects of treatment regimen (chest physiotherapy and postural drainage), with return demonstration from patient before discharge.
3. Encourage patient to avoid emotional disturbances and stressful situations.
4. Recommend strategies for smoking cessation and review progress with patient.
5. Reinforce breathing exercises and restraining and exercise programs and teach patient methods to alleviate symptoms. Instruct patient in activity pacing (avoiding activities requiring arm lifting and movement until after patient has been up or moving around for an hour or more.
6. Encourage patient to begin gradually to bathe, dress, and take short walks, resting as needed to avoid fatigue and excessive dyspnea and to keep fluids readily available.
7. Educate patient about normal anatomy and physiology of the lung, pathophysiology and changes with COPD, medications and home oxygen therapy, nutrition, respiratory therapy treatments, symptom alleviation, smoking, cessation, sexuality, coping with chronic disease, communicating with the health care team and planning for the future.
8. Teach proper use of inhalers, bronchodilators.
9. Instruct patient and family about signs and symptoms of infection or other complications and to report changes in physical or cognitive status.
10. Inform patient that smoking with or near the oxygen is extremely dangerous.
VI. EVALUATION
CLIENT CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the patient:
• Verbalized feelings and concerns about her condition,
• Participated in the activities needed in the conduction of this case, and
• Coped with her situation and lived like in a normal condition.
NURSE CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the students:
• Gained the trust of the patient to make her cooperative with the activities being conducted,
• Acquired/learned more knowledge about the disease process, its manifestation, medical management and the nursing responsibilities needed in dealing with the patient, and
• Imparted knowledge to the patient that she will use in her daily living.
College of Nursing
General Tinio Street, Cabanatuan City
A
CASE STUDY
ABOUT
“CHRONIC OBSTRUCTIVE PULMONARY DISEASE’’
Submitted by:
Karen Katrin M. Tabunan
Ayra A. Susada
Glenda Marie D. Tadiaman
Verlinda Sampana
Lou Arden Sermonia
BSN IV-J Submitted to:
Ms. Ria May R. Velasco
Ms. Gisharmaine Turner
Head Nursing
Mrs. Loida Martinez
Clinical Instructor
I. INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a disease state in which airflow is obstructed by emphysema, chronic bronchitis or both. The airflow obstruction is usually progressive, irreversible, and associated with airway hyperactivity resulting in narrowing of peripheral airways, airway flow limitation and changes in the pulmonary vasculature. Asthma now is considered as a separate disorder overlaps with symptoms of COPD. Cigarette smoking, air pollution and occupational exposure (coal, cotton and grain) are important risk factors that contribute to its development, which may occur over a 20-30 year span. Complications of COPD vary but include respiratory insufficiency and failure (major complication) as well as pneumonia, atelectasis and pneumothorax.
II. OBJECTIVES
GENERAL OBJECTIVES
After the 32 hours of duty at the Gapan District Hospital General Ward, we will be able:
• To provide a quality nursing care for the patient with chronic obstructive pulmonary disease,
• To impart our knowledge and skills in dealing with patient’s case, and
• To enhanced more our skill in doing our actual nurse nurse-patient interaction.
SPECIFIC OBJECTIVES
A. CLIENT CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the patient will be able:
• To verbalized feelings and concerns about her condition,
• To participate in the activities needed in the conduction of this case, and
• To cope with her situation and live like in a normal condition.
B. NURSE CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the students will be able:
• To gain the trust of the patient to make her cooperative with the activities being conducted,
• To acquire/learned more knowledge about the disease process, its manifestation, medical management and the nursing responsibilities needed in dealing with the patient, and
• To impart knowledge to the patient that she will use in her daily living.
III. CASE DISCUSSION
III.1 DEFINITION
Chronic obstructive pulmonary disease is a group of disorders that affect the movement of air in and out the lungs.
TYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
• Chronic Bronchitis
• Emphysema
• Bronchiectasis
CHRONIC BRONCHITIS (BLUE BLOATERS)
Chronic Bronchitis is defined as a productive cough that lasts 3 months a year for 2 consecutive years with other causes excluded. Chronic exposure to smoke or another pollutant irritates the airways resulting in hypersecretion of mucus and inflammation, thickened bronchial walls and narrow bronchial lumen. Patients have increased susceptibility to recurring infections of the lower respiratory tract.
CLINICAL MANIFESTATIONS
a. Chronic, productive cough with copious sputum in winter months.
b. Earliest sign: cough is exacerbated by cold weather, dampness and pulmonary irritants
c. Dyspnea on exertion
d. Rales/ronchi
e. Cyanosis
RISK FACTORS
a. Cigarette smoking
b. Exposure to pollution or hazardous airborne substances
c. Heredity/family history
d. Frequent respiratory infections
EMPHYSEMA (PINK PUFFERS)
Emphysema is defined as a non uniform pattern of abnormal, permanent distention of the air spaces with destruction of the alveolar walls and eventually a reduced pulmonary capillary bed. The main problem with this disease is the loss of elasticity which eventually leads to a state of CO² retention, hypoxia and respiratory acidosis.
CLINICAL MANIFESTATIONS
a. Dyspnea on exertion
b. Cough and sputum
c. Signs of respiratory distress
d. Fatigue
e. Weight loss
f. Hyper resonance on percussion
RISK FACTORS
a. cigarette smoking
b. infection
c. inhaled irritants
d. heredity
e. allergic factors
BRONCHIECTASIS
Bronchiectasis is a chronic irreversible dilatation and impaired mucociliary clearance of the bronchi and bronchioles. The result is retention of the secretions, obstructions and eventually alveolar collapse.
CLINICAL MANIFESTATIONS
a. chronic cough with sputum
b. hemoptysis
c. dyspnea
d. wheezing
e. fatigue
f. weight loss
g. fever
RISK FACTORS
a. recurrent lower respiratory tract infection
b. congenital defects
c. bronchial tumors
III.2 MEDICAL MANAGEMENT
a. Bronchodilators- any of a group of drugs that expand the air passages (bronchial tubes) of the lungs. Bronchodilators are used to treat asthma, bronchitis, emphysema, and other diseases that affect the lungs. They relieve symptoms such as wheezing, shortness of breath, and coughing, and restore the patient’s ability to breathe comfortably.
b. Oxygen therapy in low concentrations- essential for cells, which use this vital substance to liberate the energy needed for cellular activities.
c. Anti- microbial therapy with sputum culture and sensitivity studies- for the minimization of microorganisms invading the respiratory tract of the patient.
d. Prophylactic vaccination- used for the prevention of further complication like pneumonia and influenza.
e. Chest physiotherapy with percussion; postural drainage, expectorations or broncoscopy to remove bronchial secretions.
f. Increased oral fluid intake
PREVENTION
a. Smoking cessation
b. Minimizing exposure to pollutions and irritants
III.3 COLLABORATIVE PROBLEMS and its NURSING MANAGEMENT
a. Respiratory insufficiency or failure
b. Pneumonia
c. Pneumothorax
d. Pulmonary hypertension
a. RESPIRATORY INSUFFICIENCY/FAILURE
Respiratory insufficiency/ failure occur when the body can no longer maintain effective gas exchange. The physiologic process that ends in respiratory failure begins with hypoventilation of the alveoli. Hypoventilation occurs when the body’s need for oxygen exceeds actual oxygen intake, the airway is partially occluded or the transfer of oxygen and carbon dioxide in the alveolar is disrupted. This disruption may occur either because of malfunction of respiratory center stimulation or because the alveolar membrane is defective.
CLINICAL MANIFESTATIONS
a. irritability
b. lethargy
c. cyanosis
d. dyspnea
e. tachypnea
f. nasal flaring
g. intercostals retractions
h. Respiratory grunting which slows the expiratory flow and increases the lung volume and alveolar pressure (signs of severe disease and suggest onset of respiratory failure).
NURSING MANAGEMENT
a. Assess patient’s quality of respiration and rate, apical pulse and temperature
b. Monitor oxygen saturation with pulse oximetry
c. Place the patient in an upright position
d. Administer oxygen as ordered
e. Keep emergency respiratory equipment at bedside
f. Monitor for the level of consciousness
b. PNEUMONIA
Pneumonia is an inflammation of the lung parenchyma commonly caused by microbial agents. Pneumonia may be viral, bacterial, or mycoplasmal in origin. Those at risk for pneumonia often have chronic underlying disorders, severe acute illness, a suppressed immune system from disease or medications, immobility, and other factors that interfere with normal lung protective mechanisms.
CLINICAL MANIFESTATIONS
a. sudden chills, rapidly rising fever (38.5°C to 40.5°C) with profuse perspiration
b. Pleuritic chest pain aggravated by respiration and coughing
c. Severely ill patient has marked tachypnea (25-45 breaths/minute) and dyspnea; orthopnea when not propped up
d. Pulse is rapid and bounding; may increase 10 beats/minute per degree of temperature elevation (Celsius)
e. A relative bradycardia for the amount of fever suggests viral infections or mycoplasma or legionella species infections.
f. Sputum purulent, rusty, bloody-tinged, viscous or green depending in etiologic agent.
g. Other sign include crackles, and signs of lobar consolidation; initial upper respiratory tract symptoms (nasal congestion, sore throat).
h. Severe pneumonia: flushed cheeks: lips and nail beds demonstrating central cyanosis.
NURSING MANAGEMENT
a. Instruct the patient about chest splinting by hugging pillow to make coughing and breathing less painful.
b. Administer medications as prescribed by the physician.
c. Instruct the patient when an antibiotic is being given; make sure that it will be taken as full course at prescribed intervals.
d. Teach patient the proper administration of drugs and any side effects.
e. Teach the proper disposal of tissue being used by the patient to prevent the spread of microorganisms.
c. PNEUMOTHORAX
Pneumothorax occurs when the parietal or visceral pleura are breached and the pleural space is exposed to positive atmospheric pressure. Air enters the pleural space and a lung or portion of it collapses.
CLINICAL MANIFESTATIONS
a. Pleuritic pain
b. Minimal respiratory distress with small pneumothorax; acute respiratory distress if large
c. Anxiety, dyspnea, air hunger, use of accessory muscles and central cyanosis with severe hypoxemia, accompanied by tachypnea
d. Tympanic sound on percussion of the chess wall
e. Decreased or absence of breath sounds and tactile fremitus on affected side.
NURSING MANAGEMENT
a. Monitor blood oxygen level using pulse oximetry in case of hypoxia
b. Assist in chest tube insertion; maintain chest drainage or water seal.
c. Monitor respiratory status
d. Provide emotional support to the patient.
d. PULMONARY HYPERTENSION
Pulmonary hypertension is a condition that is not clinically evident until late in the disease. The systolic pulmonary arterial pressure exceeds 30 mmHg, and the mean pulmonary artery pressure is higher than 25 mmHg.
CLINICAL MANIFESTATIONS
a. Dyspnea, the main symptom, is noticed first with exacerbation and then at rest.
b. Substernal chest pain is common 25% to 50% of patients.
c. Weakness, fatigability, syncope, and occasional hemoptysis may occur
d. Signs of right sided heart failure are noted (peripheral edema, ascites, distended neck veins, liver engorgement, crackles and heart murmur).
e. ECG changes (right ventricular hypertrophy) are seen, with right axis deviation and tall peaked P waves in inferior leads and tall anterior R waves and ST segment depression or T wave inversion anteriorly.
f. PaO2 is decreased (hypoxemia).
NURSING MANAGEMENT
a. Administer prescribed oxygen therapy appropriately.
b. Be alert for signs and symptoms of the disease.
c. Prepare the emergency life saving device at bedside of the patient.
d. Administer medication as prescribed.
e. Monitor fluid intake and output carefully.
f. Promote rest for oxygen conservation.
g. Tailored sitting exercise to avoid dyspnea.
V. DISCHARGE PLANNING
1. Recommend the patient adopt a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity.
2. Demonstrate and supervise patient and family in performing all aspects of treatment regimen (chest physiotherapy and postural drainage), with return demonstration from patient before discharge.
3. Encourage patient to avoid emotional disturbances and stressful situations.
4. Recommend strategies for smoking cessation and review progress with patient.
5. Reinforce breathing exercises and restraining and exercise programs and teach patient methods to alleviate symptoms. Instruct patient in activity pacing (avoiding activities requiring arm lifting and movement until after patient has been up or moving around for an hour or more.
6. Encourage patient to begin gradually to bathe, dress, and take short walks, resting as needed to avoid fatigue and excessive dyspnea and to keep fluids readily available.
7. Educate patient about normal anatomy and physiology of the lung, pathophysiology and changes with COPD, medications and home oxygen therapy, nutrition, respiratory therapy treatments, symptom alleviation, smoking, cessation, sexuality, coping with chronic disease, communicating with the health care team and planning for the future.
8. Teach proper use of inhalers, bronchodilators.
9. Instruct patient and family about signs and symptoms of infection or other complications and to report changes in physical or cognitive status.
10. Inform patient that smoking with or near the oxygen is extremely dangerous.
VI. EVALUATION
CLIENT CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the patient:
• Verbalized feelings and concerns about her condition,
• Participated in the activities needed in the conduction of this case, and
• Coped with her situation and lived like in a normal condition.
NURSE CENTERED
After the 32 hours of duty at the Gapan District Hospital General Ward, the students:
• Gained the trust of the patient to make her cooperative with the activities being conducted,
• Acquired/learned more knowledge about the disease process, its manifestation, medical management and the nursing responsibilities needed in dealing with the patient, and
• Imparted knowledge to the patient that she will use in her daily living.
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